Moving Goal Posts- Testosterone Reference Ranges
Updated February 13, 2025
from old site;
September 13, 2021
This article covers Testosterone Reference Ranges, test limitations, and the procedure for patients visiting a TRT/HRT clinic for the first time. There is only one way to get a testosterone prescription in Calgary, Alberta or anywhere in Canada. Men must go through their Toronto, Calgary or Vancouver physician, endocrinologist or TRT clinic and request a blood test. Yes, you can get a blood test via mail order or through a naturopath. The saliva ones are not accurate and not admissible to a prescribing doctor, and the naturopath blood tests use 3rd party private companies, are limited and expensive ($600+) vs free with provincial healthcare. You need a certified laboratory to draw blood and you need a requisition to get it done.
Breaking down the testosterone reference range test
There are many issues and nuances with an accurate diagnosis. How it is constructed is flawed, the free androgen index test is not accurate, and results vary throughout the day by up to 25% as per the Alberta precision labs, but at the Mayo clinic, the (diurnal variation) fluctuation throughout the day could be as high as 50%. This being said- ideally men would not have low T or be able to access a replacement compound based several markers (mental, blood, age), not just blood tests to be able to replace what the body made naturally. But doctors can only prescribe based on the rules provided.
Blood tests only taken at peak testosterone times
The Alberta provincial standard blood test that tests testosterone reference ranges aggregates and gives a blood testosterone (free androgen index, free, bioavailable) total. The testosterone blood test is taken prior to 10am and has a range from 8.0 to 29.0 nmo/L or 230 to 836 ng/dL (USA units). Under this parameter, normal would be 18.5 nmo/L or 533 ng/dL Men’s testosterone levels peak between 7am to 10am, hence the testing time.
How low is not low enough?
Testosterone reference ranges?
The transparency is lacking in how the ranges are set- making it problematic to truly assess a patient’s hormone levels. How are the reference ranges set? Are they by committee arbitrarily setting this range? Or is it based on average men? If so, what are the composition of “healthy men”, obese, old, existing health problems, do they exercise? How big is the study size? How was the research structured? A lot of these questions are not found and are totally unknown. At the time of this article we tried to contact ALS for a breakdown- if they get back we will happily update and include the methodology.
New research suggests genetic factors may influence testosterone receptor sensitivity, meaning two men with identical blood levels could experience vastly different clinical symptoms. This biochemical individuality isn’t accounted for in current reference ranges.
Steps to get a prescription for testosterone
We are a bit biased here but the the best way is to seek out a specialized TRT/ HRT clinic in Calgary. HRT clinics are far more familiar and see many times the number of men with low testosterone than specialized endocrinologists who see patients mainly with disease related hormone issues. TRT clinics, charge a fee, generally around $1000 to have a consult with the HRT doctor, refundable if you don’t qualify. The clinic will check off the blood tests you need to get a baseline of your hormone levels.
In the second visit, the doctor will go over your hormone levels and other health markers, if you are in normal range, then you would not qualify for TRT and you would be refunded or if it is low normal you may be able to get a second hormone panel.
up to two consecutive blood tests showing chronically low testosterone is required to be able to be considered for a TRT prescription in Calgary/Toronto/Vancouver. To maintain the prescription, patients need to come in every 3 months, for the first year, then every 6 months after that. If, at any time the patient is suspected of supplementing their prescription or blood tests come back in the super physiological range the patient’s prescription will cease to be a patient of the TRT clinic.
These are the blood tests you would have to specifically request in Calgary, Toronto or Vancouver:
Sex Hormone Binding Globulin (SHBG)
Testosterone, Bioavailable (this test is not covered, paid by the patient) Testosterone, Free (Free Testosterone is a calculation involving measurement of Total Testosterone, Albumin, and Sex Hormone Binding Globulin.)